SCIENCE science.orgEDITORIAL
21 JANUARY 2022 • VOL 375 ISSUE 6578 245A
s the Biden administration took office last Janu-
ary, with the pandemic peaking at more than
130,000 COVID-19 hospitalizations in the United
States, there were high hopes for a new plan of
“sticking to the science” and expectations that
public health policies, communication, and trust
would return to levels not seen for many years.
That didn’t happen. Why?
For one, managing a public health crisis requires a
navigational system based as closely as possible on real-
time capture, analytics, and sharing of essential and
relevant information. But during the Omicron wave, we
haven’t a clue as to whether and to what extent hos-
pitalizations are being prevented by vaccinations and
boosters. The president and leading members of public
health agencies have made numerous statements and
public appearances throughout the pandemic, but not
a single word has been uttered
about fixing the profoundly
deficient data systems. In May
2021, the Centers for Disease
Control and Prevention (CDC)
declared that there would be
close tracking of all hospital-
izations and deaths among the
vaccinated. That never hap-
pened, though not because of
the CDC.
The Department of Health
and Human Services (HHS),
led by Secretary Xavier Becerra, has chosen to avoid
mandating that data be collected. Is this unwillingness
a reaction to fear of political backlash? Amid an ongo-
ing public health crisis, this inaction is unacceptable.
Mr. Becerra has also shirked other responsibilities.
There has been obvious in-fighting between the Food
and Drug Administration (FDA), the National Insti-
tutes of Health (NIH), the CDC, and the White House
COVID-19 Response Team about issues ranging from
booster shot recommendations to isolation guidelines
that omit any testing for the virus. A leader of HHS
should be mediating such conflicts, with the goal of a
single, consistent, and unified public message. That,
along with data that justify government decisions,
would promote clarity and trust.
The CDC, as the primary agency that provides the
public with pandemic guidance, is not exempt from
responsibility. In August 2021, President Biden, with
support of the White House team, NIH, CDC, and
FDA, announced that all adults would get booster
shots 6 months after their primary vaccination. Sixmonths became 8 months, then 5 months—or perhaps
the plan would be limited to certain vaccines or to
certain age groups, or was not necessary at all. Is it
any wonder that only 23% of Americans have received
a booster—in contrast to more than 50% of people in
many other countries, including the United Kingdom,
Israel, Ireland, and Denmark? Data from Israel’s Minis-
try of Health, available in late July and August during
the Delta wave, made it abundantly clear that boosters
would be necessary for preventing symptomatic infec-
tions and severe disease, but it took until late Novem-
ber for the CDC to announce that all vaccinated adults
should get a booster shot. This inevitably led to prevent-
able hospitalizations and deaths. Now with the Omicron
wave, for which booster shots have about 90% effective-
ness against hospitalization, the mistakes and delays
in communication have become magnified. Millions of
Americans would have been far
better protected against severe
disease from both Delta and
Omicron had the FDA and CDC
followed the data.
The recent gaffe with the
truncated isolation guid-
ance—10 days abruptly cut to
5—was of lesser severity with
respect to endangering people,
but the lack of any science or
evidence to back up the change
added to public confusion.
Simply acknowledging that despite the uncertainty, it
is necessary to take some action to maintain essential
workers and the health care workforce in face of the
onslaught, would have helped immensely. Further-
more, recognition of best practices for isolation from
other countries, using testing for two consecutive days
as guidance, would have been helpful. But the unwill-
ingness to do so has been thematic, and particularly
ironic given the void of American data or, in many
cases, sound practices, like masking. The world was
alerted by the South African biomedical community
of Omicron’s extreme infectiousness in November, but
there has yet to be a recommendation for improved,
medical-quality masking.
With the pandemic far from over, public health agen-
cies must take corrective action: gather and share the
data, avoid any further infighting, provide consistent,
unified communication, and have the Secretary of HHS
be an integral part of the pandemic response. It isn’t too
late to get all of this on track.
–Eric TopolIt’s not too late
Eric Topol
is a professor of
Molecular Medicine
and executive
vice president of
Scripps Research,
and founder and
director of the
Scripps Research
Translational
Institute, La Jolla,
CA, USA. etopol@
scripps.eduPublished online 18 January 2022; 10.1126/science.abo
PHOTO: SCRIPPS RESEARCH INSTITUTE
“...data that justify
government decisions
would promote
clarity and trust.”